Provider Demographics
NPI:1831297761
Name:KAKAC, KYLE D (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:D
Last Name:KAKAC
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 WILLOWBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-7199
Mailing Address - Country:US
Mailing Address - Phone:156-861-9466
Mailing Address - Fax:
Practice Address - Street 1:1416 WILLOWBROOKE CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-7199
Practice Address - Country:US
Practice Address - Phone:615-861-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116009207P00000X
IL036116009207Q00000X, 208M00000X
TN41240207Q00000X
IN01057262207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200522020Medicaid
IL3932056OtherBLUE SHIELD
TN1534607Medicaid
IL036116009-4Medicaid
IN200522020Medicaid
820900Medicare PIN
IL3932056OtherBLUE SHIELD
IL036116009-4Medicaid
TN1534607Medicaid